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Ann Surg Oncol. 2019 Dec;26(13):4337-4345. doi: 10.1245/s10434-019-07809-7. Epub 2019 Oct 11.

Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study.

Author information

1
Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada.
2
Hopital de Saint-Jerome CISSS St-Jerome, Saint-Jerome, QC, Canada.
3
Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada.
4
Centre des maladies du sein HSS CHU de Quebec, Universite Laval, Quebec, QC, Canada.
5
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
6
Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal, QC, Canada.
7
McGill University Health Centre, Montreal, QC, Canada.
8
Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada. jean-francois.boileau@mcgill.ca.

Abstract

BACKGROUND:

The sentinel node biopsy following neoadjuvant chemotherapy (SN FNAC) study has shown that in node-positive (N+) breast cancer, sentinel node biopsy (SNB) can be performed following neoadjuvant chemotherapy (NAC), with a low false negative rate (FNR = 8.4%). A secondary endpoint of the SN FNAC study was to determine whether axillary ultrasound (AxUS) could predict axillary pathological complete response (ypN0) and increase the accuracy of SNB.

METHODS:

The SN FNAC trial is a study of patients with biopsy-proven N+ breast cancer who underwent SNB followed by completion node dissection. All patients had AxUS following NAC and the axillary nodes were classified as either positive (AxUS+) or negative (AxUS-). AxUS was compared with the final axillary pathology results.

RESULTS:

There was no statistical difference in the baseline characteristics of patients with AxUS+ versus those with AxUS-. Overall, 82.5% (47/57) of AxUS+ patients had residual positive lymph nodes (ypN+) at surgery and 53.8% (42/78) of AxUS- patients had ypN+. Post NAC AxUS sensitivity was 52.8%, specificity 78.3%, and negative predictive value 46.2%. AxUS FNR was 47.2%, versus 8.4% for SNB. If post-NAC AxUS- was used to select patients for SNB, FNR would decrease from 8.4 to 2.7%. However, using post-NAC AxUS in addition to SNB as an indication for ALND would have led to unnecessary ALND in 7.8% of all patients.

CONCLUSION:

AxUS is not appropriate as a standalone staging procedure, and SNB itself is sufficient to assess the axilla post NAC in patients who present with N+ breast cancer.

PMID:
31605348
DOI:
10.1245/s10434-019-07809-7

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